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Erectile Dysfunction And Impotency : The Facts About Erection Problems

Approximately Ten Per Cent Of All Men Suffer From Erectile Dysfunction

Erectile Dysfunction, or problems having an erection is a common, worldwide condition. So, you are certainly not alone, many men are going through exactly what you are. Although Erectile Dysfunction, or problems having an erection is more common in older men, it can affect men of all ages.

Erectile dysfunction, sometimes called "impotence," is the repeated inability to get or keep an erection firm enough for sexual intercourse. The word "impotence" may also be used to describe other problems that interfere with sexual intercourse and reproduction, such as lack of sexual desire and problems with ejaculation or orgasm. Using the term erectile dysfunction makes it clear that those other problems are not involved.

Not enough blood in the penis means erection problems

An erection problem, sometimes referred to as impotence - occurs when the penis doesn't get hard (erect) enough to allow a man to have sexual activity. This happens because not enough blood can get into, or stay in the penis, long enough to allow an erection.

Erectile dysfunction can be :

·	a total inability to achieve an erection,

·	an inconsistent ability to achieve an erection, or

·	a tendency to sustain only brief erections.

These variations make defining Erectile Dysfunction difficult. In older men problems having an erection usually have a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause Erectile Dysfunction. Incidence of Erectile Dysfunction increases with age:

·	About 5 percent of 40-year-old men cannot achieve a satisfactory erection,

·	Between 15 and 25 percent of 65-year-old men cannot get an erection.

Erectile Dysfunction is treatable at any age, and awareness of this has been growing. More men have been seeking erection and impotency help and returning to normal sexual activity because of improved, successful treatments for Erectile Dysfunction, or problems having an erection.

How does an erection occur?

Erections begin with sensory or mental stimulation, or both. Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, allowing blood to flow in and fill the spaces. The blood creates pressure in the corpora cavernosa, making the penis expand. The tunica albuginea helps trap the blood in the corpora cavernosa, thereby sustaining erection. When muscles in the penis contract to stop the inflow of blood and open outflow channels, erection is reversed.

What causes Erectile Dysfunction, or problems having an erection?

Since an erection requires a precise sequence of events, Erectile Dysfunction can occur when any of the events is disrupted. The sequence includes nerve impulses in the brain, spinal column, and area around the penis, and response in muscles, fibrous tissues, veins, and arteries in and near the corpora cavernosa.

Damage to nerves, arteries, smooth muscles, and fibrous tissues, often as a result of disease, is the most common cause of Erectile Dysfunction - such as diabetes, kidney disease, chronic alcoholism, multiple sclerosis, atherosclerosis, vascular disease, and neurologic disease - account for about 70 percent of problems with having an erection. Between 35 and 50 percent of men with diabetes experience Erectile Dysfunction,.

·	Lifestyle choices that contribute to heart disease and vascular problems also raise the risk of erectile dysfunction. Smoking, being overweight, and avoiding exercise are possible causes of problems having an erection.

Also, surgery - especially radical prostate and bladder surgery for cancer - can injure nerves and arteries near the penis, causing Erectile Dysfunction. Injury to the penis, spinal cord, prostate, bladder, and pelvis can lead to Erectile Dysfunction by harming nerves, smooth muscles, arteries, and fibrous tissues of the corpora cavernosa.

·	Many common medicines - blood pressure drugs, antihistamines, antidepressants, tranquilizers, appetite suppressants, and cimetidine (an ulcer drug) - can produce Erectile Dysfunction as a side effect.

·	Experts believe that psychological factors such as stress, anxiety, guilt, depression, low self-esteem, and fear of sexual failure cause 10 to 20 percent of Erectile Dysfunction problems.

Men with a physical cause for Erectile Dysfunction, or problems having an erection frequently experience the same sort of psychological reactions (stress, anxiety, guilt, depression). Other possible causes are smoking, which affects blood flow in veins and arteries, and hormonal abnormalities, such as not enough testosterone.

How is Erectile Dysfunction Diagnosed?

Patient History : Medical and sexual histories help define the degree and nature of Erectile Dysfunction, or problems having an erection. A medical history can disclose diseases that lead to Erectile Dysfunction, or problems having an erection, while a simple recounting of sexual activity might distinguish among problems with sexual desire, erection, ejaculation, or orgasm. Using certain prescription or illegal drugs can suggest a chemical cause, since drug effects account for 25 percent of Erectile Dysfunction, or problems having an erection cases. Cutting back on or substituting certain medications can often alleviate the problem.

Physical Examination : A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to touching, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as hair pattern or breast enlargement, can point to hormonal problems, which would mean that the endocrine system is involved. The examiner might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie's disease.

Laboratory Tests : Several laboratory tests can help diagnose Erectile Dysfunction, or problems having an erection. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of free testosterone in the blood can yield information about problems with the endocrine system and is indicated especially in patients with decreased sexual desire.

Other Tests : Monitoring erections that occur during sleep (nocturnal penile tumescence) can help rule out certain psychological causes of Erectile Dysfunction, or problems having an erection. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then Erectile Dysfunction, or problems having an erection is likely to have a physical rather than psychological cause. Tests of nocturnal erections are not completely reliable, however. Scientists have not standardized such tests and have not determined when they should be applied for best results.

Psychosocial Examination : A psychosocial examination, using an interview and a questionnaire, reveals psychological factors. A man's sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.

How is Erectile Dysfunction treated?

Most physicians suggest that treatments proceed from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Quitting smoking, losing excess weight, and increasing physical activity may help some men regain sexual function.

Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If you think a particular drug is causing problems with erection, tell your doctor and ask whether you can try a different class of blood pressure medicine.

Psychotherapy and behavior modifications in selected patients are considered next if indicated, followed by oral or locally injected drugs, vacuum devices, and surgically implanted devices. In rare cases, surgery involving veins or arteries may be considered.

Psychotherapy : Experts often treat psychologically based Erectile Dysfunction, or problems having an erection using techniques that decrease the anxiety associated with intercourse. The patient's partner can help with the techniques, which include gradual development of intimacy and stimulation. Such techniques also can help relieve anxiety when Erectile Dysfunction, or problems having an erection from physical causes is being treated.

Drug Therapy : Drugs for treating Erectile Dysfunction, or problems having an erection can be taken orally, injected directly into the penis, or inserted into the urethra at the tip of the penis. In March 1998, the Food and Drug Administration (FDA) approved Viagra, the first pill to treat Erectile Dysfunction, or problems having an erection. Since that time, vardenafil hydrochloride (Levitra) and tadalafil (Cialis) have also been approved. Additional oral medicines are being tested for safety and effectiveness.

Viagra, Levitra, and Cialis all belong to a class of drugs called phosphodiesterase (PDE) inhibitors. Taken an hour before sexual activity, these drugs work by enhancing the effects of nitric oxide, a chemical that relaxes smooth muscles in the penis during sexual stimulation and allows increased blood flow.

While oral medicines improve the response to sexual stimulation, they do not trigger an automatic erection as injections do. The recommended dose for Viagra is 50 mg, and the physician may adjust this dose to 100 mg or 25 mg, depending on the patient. The recommended dose for either Levitra or Cialis is 10 mg, and the physician may adjust this dose to 20 mg if 10 mg is insufficient. A lower dose of 5 mg is available for patients who take other medicines or have conditions that may decrease the body's ability to use the drug. Levitra is also available in a 2.5 mg dose.

None of these PDE inhibitors should be used more than once a day. Men who take nitrate-based drugs such as nitroglycerin for heart problems should not use either drug because the combination can cause a sudden drop in blood pressure. Also, tell your doctor if you take any drugs called alpha-blockers, which are used to treat prostate enlargement or high blood pressure. Your doctor may need to adjust your Erectile Dysfunction, or problems having an erection prescription. Taking a PDE inhibitor and an alpha-blocker at the same time (within 4 hours) can cause a sudden drop in blood pressure.

Oral testosterone can reduce Erectile Dysfunction, or problems having an erection in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs - including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone - are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur.

Many men achieve stronger erections by injecting drugs into the penis, causing it to become engorged with blood. Drugs such as papaverine hydrochloride, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. These drugs may create unwanted side effects, however, including persistent erection (known as priapism) and scarring. Nitroglycerin, a muscle relaxant, can sometimes enhance erection when rubbed on the penis.

A system for inserting a pellet of alprostadil into the urethra is marketed as Muse. The system uses a prefilled applicator to deliver the pellet about an inch deep into the urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes. The most common side effects are aching in the penis, testicles, and area between the penis and rectum; warmth or burning sensation in the urethra; redness from increased blood flow to the penis; and minor urethral bleeding or spotting.

Research on drugs for treating Erectile Dysfunction, or problems having an erection is expanding rapidly. Patients should ask their doctor about the latest advances.

Vacuum Devices : Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The devices have three components: a plastic cylinder, into which the penis is placed; a pump, which draws air out of the cylinder; and an elastic band, which is placed around the base of the penis to maintain the erection after the cylinder is removed and during intercourse by preventing blood from flowing back into the body.

Surgery : Surgery usually has one of three goals:

·	to implant a device that can cause the penis to become erect

·	to reconstruct arteries to increase flow of blood to the penis

·	to block off veins that allow blood to leak from the penile tissues .

Implanted devices, known as prostheses, can restore erection in many men with Erectile Dysfunction, or problems having an erection. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of technological advances.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see figure 3). Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis somewhat. They also leave the penis in a more natural state when not inflated.

Surgery to repair arteries can reduce Erectile Dysfunction, or problems having an erection caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the crotch or fracture of the pelvis. The procedure is almost never successful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure - intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood that diminishes the rigidity of the penis during erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.

Impotency And Erectile Dysfunction Hope Through Research

Advances in suppositories, injectable medications, implants, and vacuum devices have expanded the options for men seeking treatment for Erectile Dysfunction, or problems having an erection. These advances have also helped increase the number of men seeking treatment. Gene therapy for Erectile Dysfunction, or problems having an erection is now being tested in several centers and may offer a long-lasting therapeutic approach for Erectile Dysfunction, or problems having an erection.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsors programs aimed at understanding the causes of erectile dysfunction and finding treatments to reverse its effects. NIDDK's Division of Kidney, Urologic, and Hematologic Diseases supported the researchers who developed Viagra and continue to support basic research into the mechanisms of erection and the diseases that impair normal function at the cellular and molecular levels, including diabetes and high blood pressure.

Points to Remember Regarding Ererctile Dysfunction And Impotency

·	Erectile Dysfunction, or problems having an erection is the repeated inability to get or keep an erection firm enough for sexual intercourse.

·	Erectile Dysfunction, or problems having an erection affects 15 to 30 million American men.

·	Erectile Dysfunction, or problems having an erection usually has a physical cause.

·	Erectile Dysfunction, or problems having an erection is treatable at all ages.

·	Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.

Erection-Inducing Drugs - Medical Treatments For Erectile Dysfunction

Oral drugs which induce and strengthen erections have revolutionised the treatment of Erectile Dysfunction, or problems having an erection. Erection inducing and erectile dysfunction drugs don’t work for everybody, but they do work for the majority of men who want stronger erections – even in diabetes. Erection inducing and erectile dysfunction drugs can also help people with neurological and spinal problems. The increasing choice of erection inducing and erectile dysfunction drugs means that if one drug doesn’t suit you,it is worth trying one of the others.

Cialis : Works in the same way as Viagra, and is popular because the erection inducement effects last so long - often more than 12 hours. The Cialis erections are not blocked by food in the stomach. Cialis side effects are similar to Viagra, but also causes back pain and muscle pain. Interactions are similar to Viagra, but also clashes with the antibiotic clarithromycin and the sedative phenobarbitone.

Levitra : Works in same way as Viagra. Side-effects and interactions of Levitra are similar to those of Viagra. Levitra erections are not as long-lasting as Cialis.

Viagra : Widens the bloods vessels, so giving an erection provided the penis is rubbed. Viagra usually works within an hour. Effect lasts for about four hours. Easily blocked by food in the stomach. Commonest side-effects of Viagra are headache, visual disturbances, blocked nose, flushed face, indigestion, palpitations – and dizziness after getting out of bed too quickly! Blue vision occurs at higher doses. Viagra is very dangerous with certain heart drugs. Interacts with many medications. Do not drink grapefruit juice on day of use.

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